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Fatty Liver Disease : Nash and Related Disorders - part 6

Một bụng trên máy vi tính chụp cắt lớp (CT) hình ảnh của một bệnh nhân phải đầy đặn góc phần tư phía trên bụng và đau. Các hình ảnh được hiển thị cho thấy rằng gan có mật độ thấp hơn so với lá lách, cho thấy gan nhiễm mỡ. Gan cũng xuất hiện mở rộng phía trước | CLINICAL MANIFESTATIONS AND DIAGNOSIS OF NAFLD Fig. 13.1 An abdominal computerized tomography CT image of a patient with right upper quadrant abdominal fullness and pain. The image shown reveals that the liver has a lower density than the spleen indicating hepatic steatosis. The liver also appears enlarged anteriorly a finding that probably explains her pain. A liver biopsy showed moderate mixed macro- and microsteatosis involving 33-66 of hepatocytes. There was mild inflammatory activity grade 1 and no significant fibrosis stage 1 . Table 13.2 Medications associated with hepatic steatosis. Macrovesicular steatosis Isoniazid Methotrexate Allopurinol Halothane a-Methyldopa Corticosteroids Microvesicular steatosis Tamoxifen Valproic acid Tetracycline Salicyclic acid Ibuprofen Fialuridine Didanosine Mixed macrovesicular microvesicular Amiodarone Perhexiline suggesting polycystic ovarian syndrome PCOS . PCOS is associated with insulin resistance 20 and may be associated with NAFLD although this has yet to be formally reported. Furthermore questions about family history of diabetes or NAFLD are important. One small study showed that out of eight families 18 family members with NAFLD were discovered 21 . Another study found that 16 out of 90 patients with NASH had a first-degree relative with the disease 22 . While no familial inheritance pattern emerged this suggests that environmental as well as genetic factors are likely to have a role in this disease. These findings have prompted the search for genetic abnormalities that may predispose susceptible individuals to NAFLD. Some of the genes currently being evaluated include those that influence development of hepatic steatosis such as leptin 23 apolipoprotein E 24 and microsomal triglyceride transfer protein MTP 25 genes encoding proteins involved in the adaptive response to oxidative stress such as manganese superoxide dismutase MnSOD 26 and genes influencing tumour necrosis factor a TNF-a expression such as CD14 27 . .